Provider Demographics
NPI:1942910351
Name:380 FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:380 FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-533-2458
Mailing Address - Street 1:1361 E UNIVERSITY DR STE 10
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7265
Mailing Address - Country:US
Mailing Address - Phone:972-533-2458
Mailing Address - Fax:
Practice Address - Street 1:1361 E UNIVERSITY DR STE 10
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7265
Practice Address - Country:US
Practice Address - Phone:972-533-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty